The Johns Hopkins Clinician Scientist
From its inception, Johns Hopkins has been dedicated to the physician-scientist. The Hopkins tri-emblem represents the three core values of the institution: teaching, patient care, and research.
Our program believes that the training of a physician-scientist begins with fundamental preparation in core disciplines. Thus, we advise students to focus primarily on medicine while in medical school, and research while in graduate school. However, we also take important steps to ensure that students are exposed to the intersection of both worlds early in their training, as well as given the professional and career development advice they need to succeed.
In a word, the MD/PhD curriculum at Johns Hopkins is flexible. Most students decide to do the first two years of medical school then begin graduate school and finish the last two years of their medical training after completing their thesis work (see the Timeline below). However, students who want more first-hand experience in clinical medicine before beginning graduate work can elect to complete three years of medical school, followed by their graduate training, and then the last year the medical school. This can give them a better appreciation of the clinical relevance of their research. In making a choice, trainees consult extensively with the Program Director, the Dean of Students, members of the MD-PhD Committee, prospective research mentors, and their faculty advisors. Students in the MD/PhD program are automatically accepted to all graduate programs, so no decision about graduate training needs to be made until more familiar with the faculty and programs.
In the fall of 2009, Johns Hopkins School of medicine began a new curriculum, “Genes to Society.” This curriculum is intended to bring medical curriculum into the modern scientific age by including cutting edge information on the genetic basis of disease and how social issues and societal pressures may interact with these determinants to promote, or limit, disease. Physiology and pathophysiology are taught together, while clinical correlations and case discussions help connect the topics discussed to the clinic. All classes are taught with a mix of lecture, labs (wet and dry), and team-based learning.
Prior to the start of the formal “Genes to Society” classes, students complete their “Scientific Foundations of Medicine” classes (macromolecules, metabolism, cell biology, genetics, epidemiology, pharmacology) and begin learning basic clinical skills (physical exam, interview techniques). The pre-clinical Genes to Society curriculum is divided into organ system-based modules (Immunology, Microbiology/Infectious disease, Hematology/Oncology, Brain/Mind/Behavior, Neuroscience and Special Senses, Pulmonology, Renal, Cardiology, Gastrointestinal/Liver, Endocrinology, Reproduction/Development, Musculoskeletal) that span from the second semester of your first year through the second semester of your second year. Additionally, to further develop the students’ clinical skills and gain knowledge of ambulatory care, during the second half of the first year and first half of the second year, students go to weekly clinical sites in the Longitudinal Clerkship. These clinical sites included affiliated hopkins as well as other hospitals and clinics in the Baltimore area.
A four week “Transition to the Wards” class is taught at the end of the pre-clinical training to prepare for life on the wards (procedures, ethics, legal). The preclinical curriculum is complete by March of your second year, which leaves about 6 months until the start of graduate school classes in the fall. Most students take the first board exam (USMLE Step 1) and do one or two clinical clerkships prior to entering graduate school. Alternatively, some students decide to finish all of third year medical school (core clerkships complete, see below) prior to beginning their PhD training.
Throughout both the pre-clinical and clinical curriculum, students participate in one week intersessions that are meant to introduce students to topics outside of the more formal curriculum (i.e. healthcare disparities, health promotion and disease prevention, global health, pain and pain management, disaster management, substance abuse, patient safety). While on the wards, intersessions continue with a focus on translational medicine-short refreshers of the basic science behind some of the clinical scenarios seen in the clerkships.
Students may study in any department of the University that supports a doctoral program approved by the Graduate Board of the Faculty of Arts and Sciences. This allows each student to join any program they wish, based on their interests and desired laboratory rotations. Additionally, since students do not need to join a graduate program until after their first few years of medical school, they can take time to learn about the different laboratories and faculty at Hopkins. Students usually choose from a broad selection of graduate programs in the School of Medicine, including:
- Biochemistry, Cellular and Molecular Biology (BCMB)
- Biological Chemistry
- Biomedical Engineering (BME)
- Human Genetics and Molecular Biology
- Cellular and Molecular Medicine (CMM)
- Molecular Biophysics
- Pharmacology and Molecular Sciences
- Cellular and Molecular Physiology
- Functional Anatomy and Evolution
- History of Science, Medicine and Technology
PhD programs in other divisions of the University, such as The Johns Hopkins Bloomberg School of Public Health (including Bioethics, Health Communication, Epidemiology, and International Health to name a few) and the School of Arts and Sciences, are also open to MD-PhD students.
Generally, students have 1-2 years of graduate class requirements and rotate through labs concurrently to find a match for a thesis lab. MD/PhD students can start work in their thesis lab early by rotating in a lab during the summer before their first year of medical school (the amount of people that do this is usually 20-50% of the incoming class) as well as between first and second year of medical school. This means a student may join their thesis lab in the first semester or two of graduate school.
All programs also require their students to pass the Graduate Board Oral (GBO) exam which tests the students’ knowledge of the graduate school curriculum in their particular field of study. The details of the timing of the thesis proposal and first committee meeting vary by program, but, generally, students will be well into their research by the end of their second year of graduate school. Once a student’s thesis work is nearly complete, the medical school administrators work with students to fold them back into the medical school clerkships at an appropriate time to allow completion of core clerkships and electives. Students can also work with the administration of their graduate school program to determine when their written thesis should be submitted (it does not have to be before returning to the wards).
Johns Hopkins takes great pride in the quality of its clinical training. The diversity of our patients, including inner city Baltimore residents, regional patients referred to a tertiary care center, and patients with rare or complex disorders who travel from across the world, as well as the quality of its physicians, students, and staff make the clinical training at Hopkins unparalleled.
The time on the wards is broken up into four quarters (and a summer period). Students must complete six required core clerkships (internal medicine, surgery, pediatrics, gynecology/obstetrics, neurology/psychiatry, emergency medicine) and a required elective in chronic care and disability. After these requirements are complete, electives and sub-internships (rotating through a department in which a student has already completed their core clerkship but taking on more responsibility-akin to an intern) may be completed. Many of these clerkships must be done at Johns Hopkins Hospital, but students may be able to complete part of a core rotation or an elective at affiliated hospitals, including Sinai Hospital and Johns Hopkins Bayview.
At the end of the fourth medical school year, students take “TRIPLE,” a class discussing Transition to Internship and Residency and Preparation for LifE. More advanced procedures and general hospital protocols are taught, as well as discussion of work/life balance and the challenges of residency.